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Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature

Year 2024, Volume: 77 Issue: 4, 351 - 355, 31.12.2024

Abstract

Objectives: Management of caustic ingestion (CI) and esophageal burns are a serious problem which causes a significant burden on the health care
services. Since absence of evidence-based guidelines optimal management of CI is still yet to be determined. The study aims to evaluate clinical
approach of Turkish pediatric surgeons to caustic esophageal burns.

Materials and Methods: The survey questions were prepared through a literature review for controversial issues. The survey was sent to 450
member of Turkish association of pediatric surgery via Google Forms and 106 of them responded.

Results: There were 46 (43%) participants who do not perform endoscopy in whether symptomatic or asymptomatic patients in the first apply. Sixty
(56%) participants preferred to perform endoscopy at the first apply. Thirty-six (34%) of participants perform endoscopy in case of certain ingestion
of caustic substance, 14 (13.5%) perform in only symptomatic patients and 10 (9.5%) perform endoscopy in any suspicion of caustic ingestion.
Seventy-one (67%) of the participants declared that they do not use antibiotics routinely and forty-six (45%) stated that they do not use steroids
with or without esophageal burns.

Conclusion: Although some studies on CI management have been published, a clear algorithm in management of CI has not established yet.
Clinicians tend to determine different follow-up and treatment algorithms based on clinical customs and their experience.

Project Number

-

References

  • 1. Bird JH, Kumar S, Paul C, et al. Controversies in the management of caustic ingestion injury: an evidence-based review. Clin Otolaryngol. 2017;42:701- 708.
  • 2. Chirica M, Resche-Rigon M, Bongrand NM, et al. Surgery for caustic injuriesof the upper gastrointestinaltract. Ann Surg. 2012;256:994-1001.
  • 3. Hugh TB, Kelly MD. Corrosive ingestion and the surgeon. J Am Coll Surg. 1999;189:508-522.
  • 4. Zargar SA, Kochhar R, Nagi B, et al. Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history. Am J Gastroenterol. 1992;87:337-341.
  • 5. Çam H, Kıray E, Taştan Y, et al. İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Acil Servisinde izlenen zehirlenme olguları Orijinal Araştırma. Türk Pediatri Arşivi. Aralık 2003;38.
  • 6. Kucuk G, Gollu G, Ates U, et al. Evaluation of esophageal injuries secondary to ingestion of unlabeled corrosive substances: pediatric case series. Arch Argent Pediatr. 2017;115:e85-e88.
  • 7. Boskovic A, Stankovic I. Predictability of gastroesophageal caustic injury from clinical findings: is endoscopy mandatory in children? Eur J Gastroenterol Hepatol. 2014 May;26:499-503.
  • 8. Zargar SA, Kochhar R, Mehta S, et al. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991;37:165-169.
  • 9. Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013;19:3918-3390.
  • 10. Bonnici KS, Wood DM, Dargan PI. Should computerised tomography replace endoscopy in the evaluation of symptomatic ingestion of corrosive substances? Clin Toxicol (Phila). 2014;52:911-925.
  • 11. Lamireau T, Rebouissoux L, Denis D, et al. Accidental caustic ingestion in children: is endoscopy always mandatory? J Pediatr Gastroenterol Nutr. 2001;33:81-84.
  • 12. Betalli P, Falchetti D, Giuliani S, et al. Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study. Gastrointest Endosc. 2008;68:434-439.
  • 13. Bonavina L, Chirica M, Skrobic O, et al. Foregut caustic injuries: results of the world society of emergency surgery consensus conference. World J Emerg Surg. 2015;10:44.
  • 14. Abbas A, Brar TS, Zori A, et al. Role of early endoscopic evaluation in decreasing morbidity, mortality, and cost after caustic ingestion: a retrospective nationwide database analysis. Dis Esophagus. 2017;30:1-11.
  • 15. Cheng HT, Cheng CL, Lin CH, et al. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol. 2008;8:31.
  • 16. Keh SM, Onyekwelu N, McManus K, et al. Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma. World J Gastroenterol. 2006;12:5223-5228.
  • 17. Ramasamy K, Gumaste VV. Corrosive ingestion in adults. J Clin Gastroenterol. 2003;37:119-124.
  • 18. Fulton JA, Hoffman RS. Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956- 2006. Clin Toxicol (Phila). 2007;45:402-408.
  • 19. Anderson KD, Rouse TM, Randolph JG. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med. 1990;323:637-640.
  • 20. Pelclová D, Navrátil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion? Toxicol Rev. 2005;24:125-129.
  • 21. Weintraub JL, Eubig J. Balloon catheter dilatation of benign esophageal strictures in children. J Vasc Interv Radiol. 2006;17:831-835.
  • 22. Youn BJ, Kim WS, Cheon JE, et al. Balloon dilatation for corrosive esophageal strictures in children: radiologic and clinical outcomes. Korean J Radiol. 2010;11:203-210.
  • 23. Josino IR, Madruga-Neto AC, et al. Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis. Gastroenterol Res Pract. 2018;2018:5874870.
  • 24. Kochhar R, Poornachandra KS. Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures. World J Gastrointest Endosc. 2010;2:61-68.
  • 25. Méndez-Nieto CM, Zarate-Mondragón F, Ramírez-Mayans J, et al. Topical mitomycin C versus intralesional triamcinolone in the management of esophageal stricture due to caustic ingestion. Rev Gastroenterol Mex. 2015;80:248-254. English, Spanish.
  • 26. Ramboer C, Verhamme M, Dhondt E, et al. Endoscopic treatment of stenosis in recurrent Crohn’s disease with balloon dilation combined with local corticosteroid injection. Gastrointest Endosc. 1995;42:252-255.
  • 27. Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointestinal Endoscopy. 2002;56:829-834.
  • 28. Camargo MA, Lopes LR, Grangeia Tde A, et al. O uso de corticoesteróides após dilata o esofágica em pacientes portadores de estenose por substâncias corrosivas: estudo prospectivo, randomizado e duplo-cego [Use- of corticosteroids after esophageal dilations on patients with corrosive stenosis: prospective, randomized and double-blind study]. Rev Assoc Med Bras (1992). 2003;49:286-292. Portuguese.
  • 29. Berger M, Ure B, Lacher M. Mitomycin C in the therapy of recurrent esophageal strictures: hype or hope? Eur J Pediatr Surg. 2012;22:109-116.
  • 30. Ghobrial CM, Eskander AE. Prospective study of the effect of topicalapplication of mitomycin C in refractory pediatric caustic esophageal strictures. Surg Endosc. 2018;32:4932-4938.
  • 31. El-Asmar KM, Hassan MA, Abdelkader HM, et al. Topical mitomycin C can effectively alleviate dysphagia in children with long-segment causticesophageal strictures. Dis Esophagus. 2015;28:422-427.
  • 32. Bartel MJ, Seeger K, Jeffers K, et al. Topical mitomycin C application in thetreatment of 1. refractory benign esophageal strictures in adults and comprehensive literature review. Dig Liver Dis. 2016;48:1058-1065.
  • 33. Soccorso G, Parikh DH. Esophageal replacement in children: challenges and long-term outcomes. J Indian Assoc Pediatr Surg. 2016;21:98-105.
  • 34. Reinberg O. Esophageal replacements in children. Ann N Y Acad Sci. 2016;1381:104-112.
  • 35. Loukogeorgakis SP, Pierro A. Replacement surgery for esophageal atresia. Eur J Pediatr Surg. 2013;23:182-190.

Kostik Özofagus Yaralanmasının Yönetimi: Türkiye’de Bir Anket Çalışması ve Literatürün Gözden Geçirilmesi

Year 2024, Volume: 77 Issue: 4, 351 - 355, 31.12.2024

Abstract

Amaç: Kostik alımı ve özofagus yanıklarının tedavisi, sağlık hizmetleri üzerinde önemli bir yük oluşturan ciddi bir sorundur. Kanıta dayalı kılavuzların
bulunmaması nedeniyle kostik alımının optimal yönetimi henüz belirlenmemiştir. Çalışma, Türk çocuk cerrahlarının kostik özofagus yanıklarına klinik
yaklaşımını değerlendirmeyi amaçlamaktadır.

Gereç ve Yöntem: Anket soruları tartışmalı konulara ilişkin literatür taraması yoluyla hazırlanmıştır. Anket, Türkiye Çocuk Cerrahisi Derneği’nin 450
üyesine Google Formlar aracılığıyla gönderildi ve 106’ı yanıt verdi.

Bulgular: İlk başvuruda semptomatik veya asemptomatik hastalara endoskopi yapmayan 46 (%43) katılımcı vardı. Altmış (%56) katılımcı
ilk başvuruda endoskopi yapmayı tercih etti. Katılımcıların 36’sı (%34) kesin kostik madde alımı durumunda endoskopi yaparken, 14’ü (%13,5)
sadece semptomatik hastalarda, 10’u (%9,5) herhangi bir kostik madde alımı şüphesi varsa endoskopi yapıyor. Katılımcıların 71’i (%67) rutin olarak
antibiyotik kullanmadığını, 46’sı (%45) özofagus yanığı olsun ya da olmasın steroid kullanmadığını belirtti.

Sonuç: Kostik alımı yönetimine ilişkin bazı güçlü çalışmalar yayınlanmış olmasına rağmen, yönetimi konusunda net bir algoritma henüz
oluşturulmamıştır. Klinisyenler klinik geleneklere ve deneyimlerine göre farklı takip ve tedavi algoritmaları belirleme eğilimindedir.

Ethical Statement

Ethical approval was obtained from the Human Research Ethics Committee of Ankara University Faculty of Medicine (date: 26.03.2020, decision no.: İ3-182-20). Informed Consent: The study did not include patients, patient consent was not obtained.

Supporting Institution

-

Project Number

-

Thanks

-

References

  • 1. Bird JH, Kumar S, Paul C, et al. Controversies in the management of caustic ingestion injury: an evidence-based review. Clin Otolaryngol. 2017;42:701- 708.
  • 2. Chirica M, Resche-Rigon M, Bongrand NM, et al. Surgery for caustic injuriesof the upper gastrointestinaltract. Ann Surg. 2012;256:994-1001.
  • 3. Hugh TB, Kelly MD. Corrosive ingestion and the surgeon. J Am Coll Surg. 1999;189:508-522.
  • 4. Zargar SA, Kochhar R, Nagi B, et al. Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history. Am J Gastroenterol. 1992;87:337-341.
  • 5. Çam H, Kıray E, Taştan Y, et al. İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Acil Servisinde izlenen zehirlenme olguları Orijinal Araştırma. Türk Pediatri Arşivi. Aralık 2003;38.
  • 6. Kucuk G, Gollu G, Ates U, et al. Evaluation of esophageal injuries secondary to ingestion of unlabeled corrosive substances: pediatric case series. Arch Argent Pediatr. 2017;115:e85-e88.
  • 7. Boskovic A, Stankovic I. Predictability of gastroesophageal caustic injury from clinical findings: is endoscopy mandatory in children? Eur J Gastroenterol Hepatol. 2014 May;26:499-503.
  • 8. Zargar SA, Kochhar R, Mehta S, et al. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991;37:165-169.
  • 9. Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013;19:3918-3390.
  • 10. Bonnici KS, Wood DM, Dargan PI. Should computerised tomography replace endoscopy in the evaluation of symptomatic ingestion of corrosive substances? Clin Toxicol (Phila). 2014;52:911-925.
  • 11. Lamireau T, Rebouissoux L, Denis D, et al. Accidental caustic ingestion in children: is endoscopy always mandatory? J Pediatr Gastroenterol Nutr. 2001;33:81-84.
  • 12. Betalli P, Falchetti D, Giuliani S, et al. Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study. Gastrointest Endosc. 2008;68:434-439.
  • 13. Bonavina L, Chirica M, Skrobic O, et al. Foregut caustic injuries: results of the world society of emergency surgery consensus conference. World J Emerg Surg. 2015;10:44.
  • 14. Abbas A, Brar TS, Zori A, et al. Role of early endoscopic evaluation in decreasing morbidity, mortality, and cost after caustic ingestion: a retrospective nationwide database analysis. Dis Esophagus. 2017;30:1-11.
  • 15. Cheng HT, Cheng CL, Lin CH, et al. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol. 2008;8:31.
  • 16. Keh SM, Onyekwelu N, McManus K, et al. Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma. World J Gastroenterol. 2006;12:5223-5228.
  • 17. Ramasamy K, Gumaste VV. Corrosive ingestion in adults. J Clin Gastroenterol. 2003;37:119-124.
  • 18. Fulton JA, Hoffman RS. Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956- 2006. Clin Toxicol (Phila). 2007;45:402-408.
  • 19. Anderson KD, Rouse TM, Randolph JG. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med. 1990;323:637-640.
  • 20. Pelclová D, Navrátil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion? Toxicol Rev. 2005;24:125-129.
  • 21. Weintraub JL, Eubig J. Balloon catheter dilatation of benign esophageal strictures in children. J Vasc Interv Radiol. 2006;17:831-835.
  • 22. Youn BJ, Kim WS, Cheon JE, et al. Balloon dilatation for corrosive esophageal strictures in children: radiologic and clinical outcomes. Korean J Radiol. 2010;11:203-210.
  • 23. Josino IR, Madruga-Neto AC, et al. Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis. Gastroenterol Res Pract. 2018;2018:5874870.
  • 24. Kochhar R, Poornachandra KS. Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures. World J Gastrointest Endosc. 2010;2:61-68.
  • 25. Méndez-Nieto CM, Zarate-Mondragón F, Ramírez-Mayans J, et al. Topical mitomycin C versus intralesional triamcinolone in the management of esophageal stricture due to caustic ingestion. Rev Gastroenterol Mex. 2015;80:248-254. English, Spanish.
  • 26. Ramboer C, Verhamme M, Dhondt E, et al. Endoscopic treatment of stenosis in recurrent Crohn’s disease with balloon dilation combined with local corticosteroid injection. Gastrointest Endosc. 1995;42:252-255.
  • 27. Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointestinal Endoscopy. 2002;56:829-834.
  • 28. Camargo MA, Lopes LR, Grangeia Tde A, et al. O uso de corticoesteróides após dilata o esofágica em pacientes portadores de estenose por substâncias corrosivas: estudo prospectivo, randomizado e duplo-cego [Use- of corticosteroids after esophageal dilations on patients with corrosive stenosis: prospective, randomized and double-blind study]. Rev Assoc Med Bras (1992). 2003;49:286-292. Portuguese.
  • 29. Berger M, Ure B, Lacher M. Mitomycin C in the therapy of recurrent esophageal strictures: hype or hope? Eur J Pediatr Surg. 2012;22:109-116.
  • 30. Ghobrial CM, Eskander AE. Prospective study of the effect of topicalapplication of mitomycin C in refractory pediatric caustic esophageal strictures. Surg Endosc. 2018;32:4932-4938.
  • 31. El-Asmar KM, Hassan MA, Abdelkader HM, et al. Topical mitomycin C can effectively alleviate dysphagia in children with long-segment causticesophageal strictures. Dis Esophagus. 2015;28:422-427.
  • 32. Bartel MJ, Seeger K, Jeffers K, et al. Topical mitomycin C application in thetreatment of 1. refractory benign esophageal strictures in adults and comprehensive literature review. Dig Liver Dis. 2016;48:1058-1065.
  • 33. Soccorso G, Parikh DH. Esophageal replacement in children: challenges and long-term outcomes. J Indian Assoc Pediatr Surg. 2016;21:98-105.
  • 34. Reinberg O. Esophageal replacements in children. Ann N Y Acad Sci. 2016;1381:104-112.
  • 35. Loukogeorgakis SP, Pierro A. Replacement surgery for esophageal atresia. Eur J Pediatr Surg. 2013;23:182-190.
There are 35 citations in total.

Details

Primary Language English
Subjects Pediatric Surgery
Journal Section Articles
Authors

Sümeyye Sözduyar 0000-0002-2767-4713

Denizcan İnal This is me 0009-0002-8587-9888

Ergun Ergün 0000-0001-8806-4022

Gülnur Göllü Bahadır 0000-0001-8163-2226

Ahmet Murat Çakmak 0000-0002-4870-8361

Ufuk Ateş 0000-0001-6591-7168

Project Number -
Publication Date December 31, 2024
Submission Date February 12, 2024
Acceptance Date October 9, 2024
Published in Issue Year 2024 Volume: 77 Issue: 4

Cite

APA Sözduyar, S., İnal, D., Ergün, E., … Göllü Bahadır, G. (2024). Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 77(4), 351-355. https://doi.org/10.4274/atfm.galenos.2024.54715
AMA Sözduyar S, İnal D, Ergün E, Göllü Bahadır G, Çakmak AM, Ateş U. Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature. Ankara Üniversitesi Tıp Fakültesi Mecmuası. December 2024;77(4):351-355. doi:10.4274/atfm.galenos.2024.54715
Chicago Sözduyar, Sümeyye, Denizcan İnal, Ergun Ergün, Gülnur Göllü Bahadır, Ahmet Murat Çakmak, and Ufuk Ateş. “Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 77, no. 4 (December 2024): 351-55. https://doi.org/10.4274/atfm.galenos.2024.54715.
EndNote Sözduyar S, İnal D, Ergün E, Göllü Bahadır G, Çakmak AM, Ateş U (December 1, 2024) Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature. Ankara Üniversitesi Tıp Fakültesi Mecmuası 77 4 351–355.
IEEE S. Sözduyar, D. İnal, E. Ergün, G. Göllü Bahadır, A. M. Çakmak, and U. Ateş, “Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 77, no. 4, pp. 351–355, 2024, doi: 10.4274/atfm.galenos.2024.54715.
ISNAD Sözduyar, Sümeyye et al. “Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 77/4 (December2024), 351-355. https://doi.org/10.4274/atfm.galenos.2024.54715.
JAMA Sözduyar S, İnal D, Ergün E, Göllü Bahadır G, Çakmak AM, Ateş U. Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2024;77:351–355.
MLA Sözduyar, Sümeyye et al. “Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 77, no. 4, 2024, pp. 351-5, doi:10.4274/atfm.galenos.2024.54715.
Vancouver Sözduyar S, İnal D, Ergün E, Göllü Bahadır G, Çakmak AM, Ateş U. Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2024;77(4):351-5.